Alzheimer’s Disease (AD) is among the most urgent health and fiscal challenges facing the United States. More than 7.4 million Americans live with AD today and it’s the sixth-leading cause of death in the country. By 2060, the number of Americans affected is projected to nearly double.

The financial toll is staggering: AD and other dementias cost Americans $409 billion in 2026, primarily through Medicare and Medicaid, with costs projected to approach $1 trillion by 2050. Families shoulder an additional $446.3 billion in unpaid caregiving annually, pulling millions of people out of the workforce.

The American public recognizes the urgency of solving the Alzheimer’s crisis. Recent polling shows nine in ten voters consider Alzheimer’s a serious national problem, and 92% support the Alzheimer’s Screening and Prevention (ASAP) Act, which would extend Medicare coverage to FDA-cleared blood tests for early screening.

It’s now possible to make breakthrough progress against this disease. Scientific advancements now enable the detection of Alzheimer’s sooner, even before memories dementia sets in, and to slow down the disease. The American public supports action. The administration can lead America to a far brighter future by declaring a new national strategy to fight Alzheimer’s.

The Alzheimer’s Policy Checklist that follows charts a clear path forward for the Administration to elevate Alzheimer’s as a national priority and lead on expanded access to early assessments, strengthened care coordination, and modernized payment policy. Taken together, these actions will ensure American innovation delivers real results for patients, families, and taxpayers.

Improve Cognitive Health Assessments and Reporting

Clarify, Strengthen, and Encourage Cognitive Assessment at Every Stage of Care. Medicare’s Initial Preventive Physical Examination (IPPE) requires a review of new beneficiaries’ functional ability and safety, but cognitive assessment is not explicitly included in the IPPE’s regulatory definition. This gap leaves more than nine in ten expected cases of mild cognitive impairment (MCI) among beneficiaries sixty-five and older undiagnosed. CMS can close this gap by revising the IPPE and Medicare Annual Wellness Visit regulations to mandate validated cognitive assessment tools in place of unstructured observation, which frequently fails to capture mild cognitive changes. CMS should also actively promote adoption of these tools.

CMS should also elevate high-value cognitive care measures into the Universal Foundation and develop new AD-specific measures spanning caregiver education and support, functional status assessment, advance care planning, timeliness of treatment initiation, and post-acute care coordination.

Benchmark and Report Cognitive Impairment Detection Rates. CMS should share MCI and dementia detection rate data with the CDC and NIH, stratified by age, race, ethnicity, geography, and socioeconomic status to find underdiagnosed populations, focus educational outreach, and track whether incentives are sufficiently incentivizing early diagnosis.

Expand Access to Early Alzheimer’s Disease Diagnosis and Care

Ensure Coverage for Alzheimer’s Blood Tests Used for Screening. Evidence continues to mount that lifestyle changes—exercise, a Mediterranean-style diet and health monitoring—can improve cognition and delay on the onset of dementia. This evidence makes the need for screening for Alzheimer’s disease more important than ever. The ASAP Act would authorize the HHS Secretary to begin Medicare coverage for FDA-cleared tests as screening tools for Alzheimer’s disease, but it would not mandate coverage. Once Congress passes this bill, HHS should implement the authority expeditiously, given the large number of American seniors transitioning to cognitive impairment each year.

Ensure Coverage for Alzheimer’s Therapies Keeps Pace with Advancements and Access Needs. The 2022 Medicare coverage policy for anti-amyloid monoclonal antibodies (mAbs) covers only specific stages of AD, leaves future indications uncovered, and saddles providers with coverage with evidence development (CED) restrictions that create unnecessary administrative burden. Medicare coverage should keep pace with scientific advancements. CMS can take action to reconsider the NCD and end the CED restrictions for these Alzheimer’s therapies based on the accumulation of evidence supporting their benefits in patients with MCI. 

Expand the GUIDE Model. The Guiding an Improved Dementia Experience (GUIDE) Model has demonstrated meaningful impact by improving quality of life, reducing caregiver burden, and helping dementia patients remain in their homes. CMS should expand the model to include patients with MCI or early-stage AD, ensuring that individuals are identified, assessed, and connected to specialty care before the disease advances and options narrow.

Engage Patient and Provider Advocacy Networks

Increase Medicare Provider Utilization of the Cognitive Assessment & Care Plan Services. As of 2021, only 2.4% of Medicare patients diagnosed with Alzheimer’s receive the Cognitive Assessment & Care Plan Services. This means far too many patients aren’t accessing the care that’s needed to manage their cognitive impairment. CMS should launch a sustained campaign for providers and patients to understand the low utilization rates and build awareness of AD’s growing prevalence, the critical importance of early diagnosis and intervention, the latest innovations in diagnosis and treatment, and the full suite of Medicare-covered services available to support high-value AD care.

Update Coding Practices to Expand Access to Earlier Alzheimer’s Care

Revamp Coding and Payment for AD Risk Assessment, Risk Management Services, and AD Diagnostic Tools. Medicare already covers structured risk assessment and management services for heart disease. CMS should build a comparable framework for AD. This means developing coding and payment for a dedicated cognitive assessment code usable at any qualifying Medicare visit, and a brain health management code for patients with MCI or early-stage dementia.

The HCPCS codes used today for cognitive assessment were built for an era in which AD was typically identified at later, more advanced stages. As diagnosis shifts earlier, CMS should comprehensively review and update cognitive assessment codes to ensure they support care at every point along the continuum, from initial cognitive risk through advanced disease.

Modernizing payment for diagnostic tools and services is equally critical. While traditional AD diagnostic methods remain costly and invasive, recently FDA-cleared blood tests offer a faster, less burdensome path to diagnosis. CMS has an opportunity to update coverage, coding, and payment accordingly to broaden patient access to diagnostic tools like blood-based biomarker tests.